PCOS (2)

Question 1

What is this?

How does it present?

What are its differentials?

What’re pts at an increased risk of?
→ What is this risk related to?

Answer 1

➊ One of the most common endocrine conditions in women that emerges at puberty. The clinical features may hyperandrogenism (hirsutism, acne, male-pattern baldness), ovulation disorders (amenorrhoea/oligomenorrhoea), and a polycystic ovarian morphology.

➋ • Hyperandogenism - Oligomenorrhoea, Hirsutism, Acne
• Insulin resistance - Obesity, OSA, Acanthosis nigricans
• Subfertility
• Mood swings, depression, anxiety
• Male pattern baldness

➌ • Hypothyroidism
• Premature ovarian failure
• Cushing’s syndrome

➍ Endometrial ca.
→ Oligomenorrhea, therefore can be reduced by ensuring regular periods

N.B. The pancreas has to produce more insulin, which promotes androgen release but prevents follicular development, therefore leading to anovulation and multiple partially-developed follicles → Polycystic ovaries

Question 2

Investigations:
What are the main investigations to do?

How is it diagnosed?

Answer 2

➊ • LH:FSH ratio - Will be raised 2x
• Testosterone - Will be raised
• Fasting and OGTT - For insulin resistance
• TVUS

N.B. Raised LH:FSH also helps exlude menopause, in which the ratio would’ve been normal

➋ Rotterdam diagnostic criteria - PCOS can be diagnosed if 2 of the following are present:
• 12+ cysts seen in one ovary/ovarian volume > 10 cm3
• Oligo/anovulation
• Clinical/biochemical features of hyperandrogenism (oligomenorrhoea, hirsutism, acne)

Question 3

Management:
What’s a vital part when managing these pts?
→ What are the benefits of this?

What other things can be given?

Answer 3

➊ Weight loss!
→ • Restores ovulation
• Makes periods more regular
• Improves fertility
• Improves hisurtism and acne

➋ • Letrozole, Clomifene, Ovarian drilling (damage hormone producing cells of ovary) - if desire to maintain fertility
• COCP - if no desire to maintain fertility
• Topical Eflornithine (for hirsutism)
* Metformin